In the end, however, there’s no mystery. The persistence of unemployment points to how badly the job market deteriorated and how tax cuts and spending cuts do little to restore it. North Carolina has cut taxes in a way that disproportionally benefits higher earners while expanding taxes or removing exemptions that helped middle-income and low-income earners and retirees. Tax breaks for the wealthy tend to go into savings while a tax break for lower income earners would have gone directly into the economy.

North Carolina’s cuts in state funding for education have an outsized impact on the economy. Unlike many states where local governments bear most of the cost of schools, North Carolina funds education primarily from the state level. Meanwhile, North Carolina’s refusal to expand Medicaid has cost the state’s economy billions of dollars in federal funds and reduced or blunted employment by hospitals.

There’s not much state government can do to escape the influence of the national economy. But states can do more to soften the effects of a national recession and speed the effects of a recovery. North Carolina should spend aggressively on education, participate fully in the Affordable Care Act and focus tax breaks lower down the income scale.

That’s not being done, and the economic pain is being extended.

Meanwhile, an editorial in the Charlotte Observer offers a glimmer of hope on this front in the form of additional confirmation from the McCrory administration that it has finally recognized one of its biggest blunders when it comes to pumping dollars into the state’s economy — the failure to expand Medicaid:

If there’s one story that’s been notably and inexplicably under-reported in the mainstream news media this week it’s been this one. As our former colleague Adam Searing, to his credit, reported Monday:

In two interviews over the last few days, North Carolina’s Secretary of the Department of Health and Human Services Dr. Aldona Wos and NC’s Medicaid Director Dr. Robin Cummings address the question of Medicaid expansion in NC: How soon, the presentation of options for policymakers and whether the state should create its own unique plan are discussed. Both officials comment on the fact that the federal government is working with states to create state-tailored plans and seem clear that North Carolina’s Governor will be presented with options for expansion that can be taken to NC’s General Assembly. No timeline is discussed, but NC’s legislature reconvenes in January 2015.

Click here to watch Health and Human Services Secretary Aldona Wos and Medicaid Director Robin Cummings finally confirm plans to do what advocates, providers and economists have been demanding for nearly two years: expand Medicaid.

If there’s anything positive about placing our state under the control of right-wing politicians, it might be this: the fact that it forces at least some people to, eventually, confront the hard reality that cut rate, on-the-cheap government rarely works. This fact is apparently being slowly brought home of late to North Carolina’s embattled Secretary of Health and Human Services, Aldona Wos.

State health officials told lawmakers Monday that they need about $6 million more a year to fix the medical examiner system, which has failed to meet minimum national standards for staffing, training and facilities.

Lou Turner, deputy section chief for the state Department of Health and Human Services, told lawmakers that the agency has been asking for more money and staff for a decade but lawmakers haven’t listened.

“It did not get funded. It did not go forward,” she said.

Put simply, Wos and her team are learning what a lot of crusading anti-government ideologues learn when they are faced with actually making the trains run on time: Notwithstanding the propaganda from the right-wing think tanks, providing high quality public services costs real money.

Let’s hope state lawmakers respond favorably to the new DHHS request and, more importantly, that North Carolina’s elected leaders learn an important lesson from the experience — namely, that it’s shortsighted and destructive to try to run the public structures and services that bind our middle class society as if they were some kind of bottom feeding chain of retail outlets.

Multiple newspapers have called for North Carolina’s Secretary of Health and Human Services Aldona Wos to resign or be fired during her first 20 months in office. Now, one of the first to speak out has done so again.

Wos’ department isn’t having a one-time issue. It has been a train wreck from the beginning.

She’s made bad hires that cost taxpayers in payouts against potential claims, put personnel in positions for which they are not prepared and awarded quarter-million dollar consulting work to her husband’s firm….

Taxpayers are bleeding from horrific mismanagement. Wos would have been long gone in any business other than politics. North Carolinians deserve better.

As Governor McCrory and his HHS Secretary Aldona Wos convene a rather strange closed door “listening session” on Medicaid in Greensboro today (it’s scheduled to last all of 45 minutes), let’s hope they both took the time over the weekend to read an excellent, “from-the-trenches” essay by Goldsboro physician Dr. David Tayloe in Raleigh’s News & Observer. In it, Tayloe explains the importance of preserving and improving North Carolina’s homegrown “medical home” model for delivering Medicaid services (Community Care of North Carolina) rather than falling for the false promises of out-of-state HMO companies that have been trying to muscle their way into the state.

CCNC is rooted in care coordinated by providers, not insurance corporations. By keeping care decisions in the hands of those most qualified to make them, medical home models improve health outcomes for North Carolina’s Medicaid population. Doctors, care managers and pharmacists across provider-led networks share data and best practices to provide efficient and high-quality care to patients, decreasing emergency room visits and reducing wasteful spending.

The CCNC model is the result of decades of work that has consistently generated positive results in North Carolina. An HMO takeover of this system would mean higher administrative costs to the state and billions of taxpayer dollars leaving the state to pay corporate shareholders. Under federal Medicaid rules, the additional money required to pay HMOs can come from only one place – sharp cuts to provider payments. When physicians choose not to participate in Medicaid, patients neglect preventive care and head to the emergency room in crisis, raising state costs while producing less positive health outcomes. Read More